What is meibomian gland dysfunction (MGD)?

The normal tears of the eye are made up of three layers – an oily (lipid) layer - the first protective layer, a watery (aqueous) layer in the middle, and a sticky (mucous) layer nearest the cornea. In MGD the glands that make the oily layer of the tears are not working properly and this allows the watery layer of the tears to evaporate. This will cause symptoms of dryness and irritation, and can cause blurry vision. Sometimes the eyes can become watery, as they produce more of the poor-quality tears to compensate.

The meibomian glands are inside the eyelids, and the openings are on the edge of the eyelids. When the glands become blocked, the oily part of the tears cannot be efficiently released. It is not usually a serious condition but If it is not treated, the glands may stop working permanently.

Dry eye disease (DED) is a multifactorial disease of the ocular surface characterized by loss of homeostasis of the tear film (the balance of the three layers is disrupted) which leads to symptoms of discomfort, visual disturbance, and instability. As well as this, there is often underlying inflammation.

Classification of dry eye disease (DED)?

DED can broadly be divided into two main but often overlapping categories:

Aqueous-deficient DED - Inadequate tear production from lacrimal glands.
Causes: Sjögren’s syndrome, lacrimal gland dysfunction, systemic medications, age-related changes.

Evaporative DED - Excessive tear film evaporation, most commonly due to MGD.
Other causes: Ocular surface exposure, low blink rate, environmental factors.

Chronic cycle of irritation, inflammation, and further gland dropout

Risk factors

MGD is a common condition and can affect anyone. However, it is more likely to happen after the age of 50, if you have diabetes or oily skin conditions and it is also more common in women.

Symptoms

• Fluctuating vision
• Blood-shot eyes
• Itchy eyes
• Watery eyes (having watery eyes can mean you are producing poor-quality tears and actually have dry eyes)
• Sore eyes
• Foreign body sensation
• Burning sensation

Treatment

At Haig-Brown Optometry we now offer intense pulsed light (IPL) and low-level light therapy (LLLT) treatment. In clinical studies this treatment has shown a positive improvement to the symptoms of dry eye disease and meibomian gland dysfunction. IPL uses thermal light pulses, to stimulate the meibomian glands to resume normal activity. It is applied to the periorbital and cheekbone areas, it heats the oil in the glands helping it flow more efficiently stimulates contraction of the glands, this increases the lipid layer of the tear film and reduces the evaporation of tears.

LLLT emits light at a specific wavelength which triggers heating of the eyelids. This treatment eases the spill of the tear film’s oily component from the eibomian glands, stabilizing the lipid layer and providing immediate relief.

Session frequency and duration

• Typically, 4 sessions spaced over 4 weeks
• Additional maintenance sessions are likely to be needed on a 6 monthly basis to maintain the treatment this will be based on individual clinical response
• Each session lasts approximately 30 minutes

Procedure steps

• The area around your eyes will be assessed and graded, measurements will be taken for baseline data and to tailor the IPL treatment to your skin. Please come to the session without contact lenses in or eye make up on, and free from moisturiser and sun screen on the face.
• Eye shields are applied to protect your eyes.
• IPL pulses are administered to the lower eyelids and cheeks.
• The shields are removed and a red-light mask is placed over closed eyes for approximately 15 minutes.

No contact with the eye itself is involved.

What to expect during treatment

• You may feel a warm snapping sensation during IPL (similar to a rubber band flick).
• LLLT feels gentle and warm, with most patients finding it very relaxing.
• You can resume normal activities immediately after the session.

Possible side effects

The treatment is generally safe, but as with any procedure, there are some potential side effects:

Uncommon:

• Mild redness or warmth of the skin around the eyes (temporary)
• Light sensitivity (usually resolves within a few hours)

Rare:

• Skin pigmentation changes or superficial skin burns (very uncommon with correct protocols)

These symptoms typically resolve within 24–48 hours. All precautions are taken to minimise risk, including the use of eye protection and skin-cooling gels if required.

Who is this treatment suitable for?

This treatment is ideal for:

• Patients with MGD and evaporative dry eye disease
• Those unresponsive to traditional therapies (e.g., warm compresses, artificial tears)
• Patients looking for non-pharmacological, non-invasive options

Contraindications include:

• Pregnancy or breastfeeding
• Photosensitive skin conditions
• Use of photosensitising medications medication* – some antibiotics (e.g. doxycycline, ciprofloxacin), some antifungals (e.g. Griseofulvin, Itraconazole), and some NSAIDs (e.g. Naproxen)
• History of seizures triggered by light

A full clinical assessment will be conducted to determine if you are a suitable candidate

*If you are unsure, please consult your Optometrist or the medical practitioner who prescribed the drugs

PLEASE NOTE: The treatment room is on the first floor, which will involve a flight of stairs. If you have mobility issues, please speak to a member of staff prior to booking.

Questions

If you have any questions about your treatment, don’t hesitate to contact us. We’re here to support you every step of the way.